Training Doctors to Disclose Unanticipated Outcomes to Patients: Randomized Trial

描述（由申请人提供）：背景：医疗护理导致的非预期结局和伤害是不可避免的。向患者披露这些结果的期望和要求越来越高，但这种做法仍然不常见，很少有医生接受过披露培训。未能持续和良好地进行披露是对以病人为中心的护理的根本威胁。许多人声称，改善披露可以提高病人的满意度，减少医疗事故索赔，但这些索赔缺乏经验证据。以前没有任何研究评估实际披露的质量，妨碍了改进披露程序的努力。目的：我们提出了一个随机试验的培训医生在披露以下具体目标：1）以确定是否医生沟通培训披露意外结果的病人 影响患者对披露的满意度; 2）探讨医生在向患者披露非预期结果方面的沟通培训是否影响医疗事故索赔; 3）探讨事件的特征（伤害的严重程度、错误的存在）、医生、患者和环境是否独立地影响非预期结果披露培训与患者满意度之间的关系。研究方法：参与者将是科罗拉多（通过COPIC获得责任保险）和华盛顿（华盛顿大学医学）的400名外科医生和介入医生。干预措施包括：a）2小时的披露培训网络广播; B）与两名标准化患者的实践和反馈;以及c）项目中期复习培训网络广播。主要结果将是患者对他们所经历的披露的满意度，如通过患者披露质量评估（一种心理测量学上合理的工具）所测量的。次要结果将是随后24个月内医疗事故索赔的发生率。还将使用多变量回归分析来检查患者、事件和医生特征对患者披露满意度的影响。影响和影响：这项研究将是第一个衡量实际披露的质量，并评估医生培训是否改善了披露过程。拟议的项目汇集了医疗差错，医疗事故和沟通技能培训的领先研究人员与两个行业合作伙伴-一个主要的医疗事故保险公司和TMIT，在基于网络的安全教育的领导者。研究结果将广泛适用于培训医生，以满足日益增长的需求，有效披露。

DESCRIPTION (provided by applicant): Background: Unanticipated outcomes and harms resulting from medical care are inevitable. Disclosure of those outcomes to patients is increasingly expected and required, but this practice remains uncommon and few physicians have had disclosure training. Failure to conduct disclosure consistently and well represents a fundamental threat to patient-centered care. Many have asserted that improving disclosure could increase patient satisfaction and reduce malpractice claims, but empirical evidence for these claims is lacking. No prior studies have assessed the quality of actual disclosures, hampering efforts to improve the disclosure process. Objectives: We propose a randomized trial of training physicians in disclosure with the following specific aims: 1) to determine whether physician communication training in disclosing unanticipated outcomes to patients affects patient satisfaction with disclosure; 2) to explore whether physician communication training in disclosing unanticipated outcomes to patients affects malpractice claims; 3) to explore whether characteristics of the event (severity of harm, presence of error), the physician, patient, and the environment independently affect the relationship between unanticipated outcome disclosure training and patient satisfaction. Methods: Participants will be 400 surgeons and interventional physicians in Colorado (who obtain liability insurance through COPIC) and in Washington (UW Medicine). The intervention includes: a) 2-hour disclosure training webcast; b) practice and feedback with two standardized patients; and c) a refresher training webcast mid-project. The primary outcome will be patient satisfaction with a disclosure they experience, as measured with the Patient Assessment of Disclosure Quality, a psychometrically sound instrument. The secondary outcome will be the incidence of malpractice claims in the subsequent 24 months. Multivariate regression analysis will also be used to examine the effects of patient, event, and physician characteristics on patient satisfaction with disclosure. Implications and Impact: This study will be the first to measure the quality of actual disclosures and assess whether physician training improves the disclosure process. The proposed project brings together leading researchers in medical error, malpractice, and communication skills training with two industry partners--a major malpractice insurance company and TMIT, a leader in web-based safety education. The findings will be widely applicable to training physicians to meet the increasing demands for effective disclosure.